Come for the politics, stay for the snark.

Reality always wins in the end.

We need fewer warriors in public service and more gardeners.

Saul Alinsky is my co-pilot.

… riddled with inexplicable and elementary errors of law and fact

There will be lawyers.

I did not have this on my fuck 2020 bingo card.

My years-long effort to drive family and friends away has really paid off this year.

Wetsuit optional.

Balloon Juice has never been a refuge for the linguistically delicate.

Nevertheless, she persisted.

So it was an October Surprise A Day, like an Advent calendar but for crime.

I can’t take this shit today. I just can’t.

It’s always darkest before the other shoe drops.

The willow is too close to the house.

This is all too absurd to be reality, right?

A snarling mass of vitriolic jackals

All your base are belong to Tunch.

False Scribes! False Scribes!

I’d like to think you all would remain faithful to me if I ever tried to have some of you killed.

You can’t attract Republican voters. You can only out organize them.

Han shot first.

This fight is for everything.

Militantly superior in their own minds…

Shallow, uninformed, and lacking identity

Open Thread: The Biter Bit

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Steve Coll, in the New Yorker, on Mitch McConnell and “The Tea Party’s Revenge“:

… Like a guerrilla army, the Tea Party is learning how to influence public opinion even when it loses a conventional battle. The budget caps that Obama conceded in 2011 have already enshrined in law a portion of the movement’s draconian fiscal agenda. And although Cruz and his allies in the House won no additional cuts this time, they managed to spread magical thinking among their followers about a possible future debt default. (The next debt-ceiling deadline arrives early next year.) Cruz and the others systematically promoted the idea—the fantasy—that, if the Treasury Department were prohibited from issuing any new debt to finance interest payments and government operations, the country would do just fine. The global economy, this story goes, far from collapsing into crisis, would prove resilient, and, while some nonessential federal departments might wither for lack of funds, that would only demonstrate how Americans could get by with a much smaller government.

This campaign has been dismissed by some Wall Street analysts as just a form of coercive bargaining. Washington is a grand opera of phony crises. Congress has raised the debt ceiling more than seventy times since 1960 without forcing an actual default. It’s tempting to believe that even a diva like Cruz, who, after all, holds a law degree from Harvard and evidently aspires to higher office, would never countenance a final default. Yet history is rife with political radicals who have shocked the world by doing just what they always said they would: Confederate secessionists, for example, who seem to inspire so many Tea Partiers today…

As recently as 2007… it still seemed possible that a modernizing Republican Party might build a formidable political coalition of Latinos, evangelicals, disaffected Catholic Democrats, high-tech entrepreneurs, libertarians, social and educational reformers, and eclectic independents. Instead, as Geoffrey Kabaservice puts it in his history of the Republican decline, “Rule and Ruin,” movement conservatives have “succeeded in silencing, co-opting, repelling, or expelling nearly every competing strain of Republicanism from the party.” Political purges have no logical end point; each newly drawn inner circle of orthodoxy leaves a former respected acolyte suddenly on the outside. That a Tea Party-influenced purification drive now threatens such a loyal opportunist and boardroom favorite as Mitch McConnell seems a marker of the times.

McConnell’s would-be usurper is Matt Bevin, a businessman who owns a bell company; his campaign slogan is “Let Freedom Ring.” He told Glenn Beck recently, “We have got to wean people from this idea of free lunches.” (He might start with fellow Kentuckians; their state pays sixty-six cents in federal taxes for every dollar of federal spending it takes in.) Bevin pleaded, “What we need to tell the American people is that the party’s over.” Presumably, he didn’t mean the Grand Old Party, but the American people may be forgiven for thinking that he did.

***********
What’s on the agenda for the start of another week?

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Sports Open Thread

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Those who know what you’re watching seem to be off watching.

For token actual content (just in case your team lost) I offer Leigh Cowan’s evisceration of Malcolm Gladwell, “The Killing Point“:

… Gladwell cherry-picks his way through the complicated fields of physiology, genetics, and sport to frame an argument that is not only ill-informed, it’s downright dangerous.

His argument? Performance-enhancing drugs make sports fairer. Based on the premise that genetic differences make athletic competitions inherently unfair, he argues that athletes should be allowed to use substances to compensate for these differences. Not only that, he even suggests that it is perhaps more commendable to use pharmaceuticals than it is to be born “lucky.”…

The use of performance-enhancing drugs presents the chance to explore an interesting ethical dilemma. The problem, however, is in Gladwell’s omissions. His piece paints a rosy portrait of pharmaceutical enhancements. He likens them to the adoption of iodized salt. It has all the context of a sales pitch.

What Gladwell fails to mention – at all – are the risks involved in using performance-enhancing drugs. There is nothing about the risks of blood doping or of pharmaceutical enhancement. He even skips the risks inherent in the very genetic condition he holds up as “lucky.” There is no mention of contact sports, where the decision to illegally enhance could be the difference between life and death for your competitor. There is no recognition that healthcare access for athletes is a continuum with the Lance Armstrongs at the upper end, with their elite teams of morally questionable medical practitioners,and with some kid at the bottom end, desperate for a place on the team, taking injectables that he gets from a friend of a friend…

That Gladwell can proclaim the moral superiority of performance enhancement with no mention of the enormous physical toll that these drugs exact is fucking outrageous. Athletes are already testing the fringes of bodily limitations. Our blood, our hormones, our entire physical systems exist within certain parameters because those are limits that allow everything to work properly. Those limits keep us alive. So yes, of course it’s fucking dangerous to screw around with that shit. Of course there are consequences. People die….

(NSFWCorp subscriptions available here.)

So… which teams are we cheering for, this evening?

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Open Thread: Camelot (What Might Have Been)

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Whole spate of new Kennedy books timed for November’s anniversary, and historians are still turning up new details. The Washington Post reviewed a bunch of them; here’s Evan Thomas on Robert Dallek’s ‘Camelot’s Court: Inside the Kennedy White House’:

… Kennedy was devoted to the Great Man theory of history. As he spoke about Churchill, Stalin and Napoleon, “his eyes shone with a particular glitter, and it was quite clear that he thought in terms of great men and what they were able to do, not at all of impersonal forces,” observed the British historian Isaiah Berlin after several conversations with Kennedy at White House dinners. But of course even the greatest men, from time to time, need wise advisers to battle the impersonal forces. Kennedy surrounded himself with what he called a “ministry of talent,” personified by McGeorge Bundy, the brainy but chilly Harvard dean who became national security adviser. These men — and they were all men back then — were well-intentioned, but, as Dallek shows, they often served Kennedy badly.

In particular, they had difficulty handling the military and the intelligence community. The current Pentagon is relatively restrained about the use of force. Not so the top brass in 1961. Consider Air Force Gen. Thomas Power, the head of the Strategic Air Command. “Why are you so concerned with saving lives?” Power once asked the authors of a Rand Corp. study. “The whole idea is to kill the bastards. At the end of the war if there are two Americans and one Russian left alive, we win.”

Power’s boss, Air Force Chief of Staff Curtis LeMay — a model for Gen. Jack D. Ripper in the doomsday movie “Dr. Strangelove” — described Power as a “sadist” and “not stable.”

In his first few months in office, Kennedy was bamboozled by the CIA, which persuaded the new president to back a “secret” invasion of Cuba. The Bay of Pigs was a fiasco. After the defeat, Jackie Kennedy recalled her husband crying in the privacy of his bedroom. “He put his head in his hands and sort of wept,” she said, according to Dallek’s recounting. John Kennedy’s repeated refrain: “All my life I’ve known better than to depend on the experts. How could I have been so stupid, to let them go ahead?”…

And here’s Thurston Clark on ‘Why we’re still obsessed with John F. Kennedy‘:

… One of the greatest challenges Kennedy poses to anyone writing about him is that, because he rigorously compartmentalized his friends and family members, their impressions and recollections of him are sometimes at odds…

Three days before going to Dallas, he told Lincoln he was thinking of replacing Lyndon Johnson with North Carolina Gov. Terry Sanford as his running mate in 1964, but he did not share this bombshell with his brother Bobby, with whom he often spoke several times a day. Not surprisingly, Bobby later dismissed the conversation as a fabrication, telling historian Arthur Schlesinger, “Can you imagine the president ever having a talk with Evelyn about a subject like that?” Yet when former Cabinet member Abe Ribicoff went sailing with Bobby several months after Dallas, he was shocked to discover that he knew things about John that Bobby did not, confirming his impression that the president had “exposed different facets of himself to different people.”…

In a 1986 set of recollections by close associates of Johnson, I found that, according to speechwriter and adviser Horace Busby, two weeks before JFK traveled to Texas, Johnson told Busby that when he was with the president in Austin on the evening of Nov. 22, he would tell him he had decided against running for vice president in 1964 and would instead return to Texas to run a newspaper. Busby doubted that he was serious and thought that LBJ just wanted the president to cajole and flatter him. But given Kennedy’s increasing estrangement from Johnson, it is possible that he would have accepted his offer with alacrity…

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Dessert Topping and Floor Wax

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Health insurance in the United States has a structural history of indemnity insurance.  The philosophical underpinning is that health insurance should be sufficient to pay for the activities and procedures that get a worker back on his feet and back to work after an accident or unexpected illness.  It aims to intervene in short bursts without long sustaining interventions. The goal is to get someone back to health after a temporary downturn.

This plays out in benefit design.  For instance, Medicare (which follows the indemnity model) covers the first sixty days of hospitalization at a high benefit level, the next thirty at a medium level and then the regular benefit runs out.  There is a lifetime reserve of 60 days where Medicare effectively pays 50% of the base rate, and after those are exhausted, Medicare covers nothing.  My personal insurance covers 25 physical therapy sessions a year.

These are limited, acute situations that are being covered.  They are not long term nor chronic conditions where improvement is a low probability event.

Medicaid is not like Medicare or most private health insurance in this country. Medicaid is schizophrenic in its benefit design.  For relatively healthy and young people who have Medicaid, it is functionally similar to Medicare or any other insurance plan.  People go to the doctor’s office, get a prescription, and perhaps pay a small co-pay and then go home.  There is nothing unusual in Medicaid being a dessert topping here.

However, Medicaid serves a second function that no other health insurance program serves.  It is the payer of last resort for long term care in this country. Medicaid eligibility for nursing home care is fairly restrictive — people who qualify can not have a significant number of assets in their name.  Medicaid is also a floor wax.

The federal floor is $2,000 in personal assets, although states may allow higher limits, and the signing over of most personal income.  For instance a 67 year old on Social Security and needing Medicaid for nursing home care can expect to sign over 90% of their check to cover a portion of their nursing home expenses.

This dual nature of Medicaid instead creates a few odd rules.  The first is the look-back rule.  Since nursing home care is extremely expensive, Medicaid does not want to pay unless there is a clear need.  If an individual with significant assets begins to transfer the ownership of those assets to family members right before Medicaid payments begin, Medicaid will go after those assets as a transfer meant to hide assets.  Estate recovery is similar in that Medicaid can go after an estate for assets that it did not know about to cover the costs of nursing home care.

Medicaid’s ability to do so is restricted to individuals over the age of 55 and to those who get long term care.  The goal is to provide an incentive for people to pay for their own long term care via either self-funding or the purchase of private long term care insurance.

I don’t think the MA expansion changes these rules.  Individuals over the age of 55 who get regular medical coverage won’t have to see their assets or income attached.  Individuals who receive nursing home care will see Medicaid administrators going after assets and income streams if those exist.

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